Use of intravenous tigecycline in patients with severe Clostridium difficile infection: a retrospective observational cohort study.

There are only a limited number of antimicrobials for treating severe Clostridium difficile infection (sCDI). Tigecycline shows significant in vitro effect against C. difficile and is approved for management of complicated intra-abdominal infections. Our aim was to analyse the efficacy of tigecycline compared with standard therapy (oral vancomycin plus intravenous metronidazole) in adults treated for sCDI. A retrospective cohort study of such patients hospitalized at our department from January 2014 to December 2015 was performed. Patients receiving tigecycline monotherapy were compared with patients treated with standard therapy alone. Diagnosis and severity of CDI were determined according to guidelines of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). Primary outcome was clinical recovery, secondary outcomes were in-hospital and 90-day all-cause mortality and relapse, colectomy, and complication rates. Of the 359 patients hospitalized for sCDI, 90 (25.0%) were included, 45 in each group. Patients treated with tigecycline had significantly better outcomes of clinical cure (34/45, 75.6% vs. 24/45, 53.3%; p 0.02), less complicated disease course (13/45, 28.9% vs. 24/45, 53.3%; p 0.02), and less CDI sepsis (7/45, 15.6% vs. 18/45, 40.0%; p 0.009) compared with patients receiving standard therapy. Tigecycline usage was not associated with adverse drug reactions or need for colectomy. Rates of ileus, toxic megacolon, mortality, and relapse were similar between the two groups. Favourable outcomes suggest that tigecycline might be considered as a potential candidate for therapeutic use in cases of sCDI refractory to standard treatment.

Vancomycin-resistant Enterococcus faecalis colonization during recovery from Neisseria meningitidis cerebrospinal meningitis. Case report.

A 19-year-old man had been admitted to the Hospital because of septic shock and large scale suffusions all over the body. The pathogen had proved to be Neisseria meningitidis serogroup C. In his stabilization period two superinfectious attacks arose. One of them was a bacteremia, caused by a vancomycin-sensitive Enterococcus faecium. The second was a wound infection in his deep colliquating necrotised tissue of the heel. Vancomycin-resistant Enterococcus faecalis (VREF) was isolated from this lesion with some Gram-negative opportunistic pathogens. The strain contained the vanA gene. After systemic and topical treatment, furthermore plastic surgical interventions the patient recovered. This is the second report on VREF from Hungary colonizing/infecting a patient with an underlying disease.

Effect of fluoride on cariogenic oral microorganisms (an in vitro study).

The effect of sodium fluoride and sodium monofluorophosphate at concentrations of 1, 5, 10, 50, 100 and 1000 mg/l in phosphate buffer (pH 6.5) as well as in UHT milk were studied on cultures and suspensions of Streptococcus mutans, Lactobacillus acidophilus and Candida albicans. Using serial tenfold dilutions up to 10(-7) of 24-48 hour cultures, a subsequent 0, 60 and 120 min incubation caused no decrease in the number of CFUs. Growth kinetic studies in the Bioscreen biophotometer (Labsystem, Finland) revealed that sodium fluoride in different concentrations (from 0.875 mg/l up to 500 mg/l) influenced the growth dynamics of S. mutans and C. albicans: the exponential phase flattened out at the highest fluoride concentrations (500 mg/l) present in the growth media. The lag phase of C. albicans became longer. The results of these experiments indicate that sodium fluoride administered at higher concentrations than the usual caries preventive dosage made the generation time of cariogenic oral bacteria and fungi longer, slowing down their multiplication.

Pathogenesis, microbiological and clinical aspects of oral candidiasis (candidosis).

The clinical significance of the oral candidiasis (either as independent disorder, or as a part of another disease) is increasing with time. The diagnosis and local treatment of the oral candidiasis may not be satisfactory, this disorder cannot be eliminated without the correct diagnosis and management of the underlying disease. At the same time, some disorders, such as Candida induced leukoplakia, may significantly enhance tumor development. Fungal infection of the mouth is often the initial sign of several immunodeficiency diseases. It is, therefore, very important to clarify the background of a fungal infection, since this may be critical regarding the prognosis.

[Molecular pathogenesis of oral candidiasis (candidosis)]. / Az oralis candidiasis (candidosis) molekuláris patogenezise.

Candida species are the most important pathogenic fungi in the oral cavity with the predominance of Candida albicans. In this review the authors summarise the most important cell-surface bound pathogenical factors such as fibrinogen, fibronectin, thrombin, collagen, laminin and vitronectin-binding proteins and extracellular virulence enzymes of Candida albicans and some microbiological aspects of oral candidiasis (candidosis). Adherence to both artificial and mucosal surfaces is mediated by hydrophobic interactions and by ligand-receptor attachment. Surface bound proteins on Candida cells bind to mucosal surface proteins. Broad spectrum antibacterial treatment liberates binding sites for Candida colonisation by means of reducing the number of bacterial normal flora in the oral cavity. Non immune humoral factors such as iron, lysosyme, hystidine-rich-polypeptides, lactoferrin, lactoperoxidase and immune globulins such as s-IgA, moreover, elements of cellular immunity, especially polymorphonuclear leucocytes contribute to preventing the establishment of Candida infection. A disbalance in these constituents may result in colonisation and biofilm production of Candida. The biofilm consist of serum proteins mainly fibrin, desquamated epithelial cells, dead leukocytes, living and multiplying candida cells, pseudohyphae and extracellular matrix excreted by candida cells. Living candida cells are deeply embedded in the biofilm, thus protected from defence mechanisms of the host. Continuous destruction of mucosal surfaces beneath the biofilm may create a portal of entry for systematic candidal infections.

[Clinical, microbiological and therapeutic aspects of oral candidiasis (candidosis)]. / Az oralis candidiasis (candidosis) klinikai mikrobiológiai és terápiás vonatkozásai.

Exogenic, prosthetical and endogenic factors that may influence and facilitate fungal infections of the oral cavity are summarized. The clinical classification of the oral candidiasis is based on the criteria accepted in the international literature. The main points for the classification are the clinical appearances, the histopathological alterations and the possible manifestation of an underlying disease. In the last part of the review a brief summary is given on the antifungal agents such as polyenes, azole-derivatives and DNA analogs available for candidiasis.